Which statement is true regarding a POS plan?

Which statement is true regarding a POS plan?

• A. A POS plan is completely capitated.
• B. A POS plan permits the member to choose among different plan options at the time medical service is needed.
• C. A POS plan requires referral from PCP for any service.
• D. A POS plan does not allow out-of-network services.

Answer: (B)

POS plans blend features of HMOs and PPOs, giving members flexibility at the point of service. You typically have a primary care physician and may need referrals to see specialists within the network, but you’re not limited to in-network care. If you choose to go out-of-network, you can still get covered, though with different (usually higher) cost sharing. The key idea is that you can decide, at the time you need care, whether to stay in-network or go out-of-network, which is why this option is the best description of a POS plan. The other statements aren’t correct because POS plans aren’t defined by complete capitations, they don’t require a referral for every service, and they do allow out-of-network services with different cost implications.

POS plans blend features of HMOs and PPOs, giving members flexibility at the point of service. You typically have a primary care physician and may need referrals to see specialists within the network, but you’re not limited to in-network care. If you choose to go out-of-network, you can still get covered, though with different (usually higher) cost sharing. The key idea is that you can decide, at the time you need care, whether to stay in-network or go out-of-network, which is why this option is the best description of a POS plan. The other statements aren’t correct because POS plans aren’t defined by complete capitations, they don’t require a referral for every service, and they do allow out-of-network services with different cost implications.